Tablet and web-based audiometry to screen for hearing loss in adults with cystic fibrosis.

INTRODUCTION: Individuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry in a sound-booth is costly, time-consuming and requires a trained audiologist. This cross-sectional study analysed tablet-based audiometry (Shoebox MD) performed by non-audiologists in an outpatient setting, alongside home web-based audiometry (3D Tune-In) to screen for hearing loss in adults with CF. METHODS: Hearing was analysed in 126 CF adults using validated questionnaires, a web self-hearing test (0.5 to 4 kHz), tablet (0.25 to 12 kHz) and sound-booth audiometry (0.25 to 12 kHz). A threshold of ≥25 dB hearing loss at ≥1 audiometric frequency was considered abnormal. Demographics and mitochondrial DNA sequencing were used to analyse risk factors, and accuracy and usability of hearing tests determined. RESULTS: Prevalence of hearing loss within any frequency band tested was 48%. Multivariate analysis showed age (OR 1.127; (95% CI: 1.07 to 1.18; p value<0.0001) per year older) and total intravenous antibiotic days over 10 years (OR 1.006; (95% CI: 1.002 to 1.010; p value=0.004) per further intravenous day) were significantly associated with increased risk of hearing loss. Tablet audiometry had good usability, was 93% sensitive, 88% specific with 94% negative predictive value to screen for hearing loss compared with web self-test audiometry and questionnaires which had poor sensitivity (17% and 13%, respectively). Intraclass correlation (ICC) of tablet versus sound-booth audiometry showed high correlation (ICC >0.9) at all frequencies ≥4 kHz. CONCLUSIONS: Adults with CF have a high prevalence of drug-related hearing loss and tablet-based audiometry can be a practical, accurate screening tool within integrated ototoxicity monitoring programmes for early detection.

A Laboratory Evaluation of Contextual Factors Affecting Ratings of Speech in Noise: Implications for Ecological Momentary Assessment.

OBJECTIVES: As hearing aid outcome measures move from retrospective to momentary assessments, it is important to understand how contextual factors influence subjective ratings. Under laboratory-controlled conditions, we examined whether subjective ratings changed as a function of acoustics, response timing, and task variables. DESIGN: Eighteen adults (age 21 to 85 years; M = 51.4) with sensorineural hearing loss were fitted with hearing aids. Sentences in noise were presented at 3 overall levels (50, 65, and 80 dB SPL) and 3 signal to noise ratios (0, +5, and +10 dB signal to noise ratio [SNR]). Listeners rated three sound quality dimensions (intelligibility, noisiness, and loudness) under four experimental conditions that manipulated timing and task focus. RESULTS: The quality ratings changed as the acoustics changed: intelligibility ratings increased with input level (p < 0.05); noisiness ratings increased at poorer SNRs (p < 0.05); and loudness ratings increased as input level increased (p < 0.05). Timing of rating was significant at the highest presentation level (80 dB SPL): Participants gave higher noise ratings while listening to the signal than afterward (p < 0.05). Presence of a secondary task had no significant effect on ratings (p > 0.1). CONCLUSIONS: The findings of this laboratory study provide evidence to support the conclusion that group-mean listener ratings of loudness, noisiness, and intelligibility change in predictable ways as level and SNR of the speech in noise stimulus are altered. They also provide weak evidence to support the conclusion that timing of the ratings (during or immediately after sound exposure) can affect noisiness ratings under certain conditions, but no evidence to support the conclusion that timing affects other quality ratings. There is also no evidence to support the conclusion that quality ratings are influenced by the presence of, or focus on, a secondary nonauditory task of the type used here.